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| 성인에서 장기간 Furosemide 오용과 연관된 신수질 석회화 |
| 김윤구 , 이윤하 , 이규백 , 장세호 , 김대중 , 오하영 , 김보현 , 김미경 , 조윤숙 |
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| Abstract |
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Although furosemide therapy is an important risk factor for medullary nephrocalcinosis in neonates, it is not certain in adults. We examined nephmcal- cinosis in six successive patients with long-term furosemide abuse(male: female = 1: 5, age range 28 -39 years) by renal ultrasonography(US) and com- puted tomography(CT) between July 1992 and Feb- ruary 1996. All six patients were normotensive and showed hypokalemia(range 2.3-3.1meq/L) and meta- bolic alkalosis at the time of presentation. The serum creatinine and creatinine clearance ranged from 0.7 to 1.5mg/dl and from 39.2 to 99.0ml/min, respecti- vely, and hyperuricemia(range 8.5-12.9mg/dl) was observed in five patients. Furosemide abuse was confirmed by history in five patients and by urine assay for diuretics in one patient who denied diuretic abuse. The daily dose and duration of conti- nuous intake of furosemide ranged from 4hng to 1600mg and from 4 to 20 years, respectively. Renal US showed diffuse increase in echogenicity in the medullary pyramids and/or echogenic rings in the periphery of renal pyramids in all six patients. Medullary calcifications, which were concentrated mainly at the outer medulla, were demonstrated by CT in four patients. The calcification was not de- tectable on plain abdominal radiography except in one patient. In two patients induding one in whom the calcification -was not demonstrated by CT, kidney biopsy findings showed tubulointerstitial fi- brosis and atrophy with fine calcifications in the interstitiums and tubules particularly at the outer medulla. We conclude that long-term furosemide abuse may cause medullary nephrocalcinosis in adults and medullary nephrocalcinosis detected by US and/or CT in adult patients with otherwise unexplained hy- pokalemia may be a clue in the diagnosis of long- term furosemide abuse. |
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